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Potentially inappropriate medication prescribing by nurse practitioners and physicians
Lin-Na Chou1,2, Yong-Fang Kuo1,2,3,4, Mukaila A Raji3,4
1Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA.
Journal of the American Geriatrics Society
|March 22, 2021
Summary
Nurse practitioners (NPs) prescribe fewer potentially inappropriate medications (PIMs) than physicians, reducing PIM use and improving patient safety. This finding highlights the importance of provider type in PIM prescribing patterns.
Area of Science:
- Geriatrics
- Health Services Research
- Pharmacology
Background:
- Potentially inappropriate medication (PIM) use is a significant risk factor for adverse health outcomes, including hospitalization and mortality.
- Limited research has explored the influence of healthcare provider type on PIM prescribing patterns.
Purpose of the Study:
- To compare the rates of initial and refill PIM prescriptions between physician and nurse practitioner (NP) visits.
- To determine the impact of provider type on PIM prescribing practices.
Main Methods:
- Analysis of 100% of Texas Medicare data from 2016.
- Distinguishing between initial and refill PIM prescriptions for physician and NP visits.
- Calculating PIM rates and adjusted odds ratios (OR) by provider type.
Main Results:
- The overall PIM prescription rate was 24.1 per 1000 visits (9.0 initial, 15.1 refill).
- Visits with NPs showed lower odds of initial PIM prescriptions (OR=0.74) and PIM refills (OR=0.54) compared to physician visits.
- The reduced odds of PIMs with NPs were more pronounced in Black enrollees, older patients, and those with more comorbidities.
Conclusions:
- Nurse practitioners (NPs) demonstrate lower rates of both initial and refill PIM prescriptions compared to physicians.
- The observed differences in PIM prescribing between NPs and physicians vary based on patient demographics and clinical factors such as age, race/ethnicity, and comorbidities.
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